Pub Date : 2021-01-01DOI: 10.1136/bmjstel-2020-000626
Hani M S Lababidi, Usamah Alzoraigi, Abdullah Abdulaziz Almarshed, Waleed AlHarbi, Mohamad AlAmar, Amer A Arab, Mahmoud A Mukahal, Faisal A AlAsmari, Bandar Y Mzahim, Husam A M AlHarastani, Salem S Alammi, Yousef I AlAwad
Background: COVID-19 pandemic is presenting serious challenges to the world's healthcare systems. The high communicability of the COVID-19 necessitates robust medical preparedness and vigilance.
Objective: To report on the simulation-based training and test preparedness activities to prepare healthcare workers (HCWs) for effective and safe handling of patients with COVID-19.
Methodology: Two activities were conducted: simulation-based training to all HCWs and a full-scale unannounced simulation-based disaster exercise at King Fahad Medical City (KFMC). The online module was designed to enhance the knowledge on COVID-19. This module was available to all KFMC staff. The five hands-on practical part of the course was available to frontliner HCWs. The unannounced undercover simulated patients' full-scale COVID-19 simulation-based disaster exercise took place in the emergency department over 3 hours. Six scenarios were executed to test the existing plan in providing care of suspected COVID-19 cases.
Results: 2620 HCWs took the online module, 17 courses were conducted and 337 frontliner HCWs were trained. 94% of learners were satisfied and recommended the activity to others. The overall compliance rate of the full-scale COVID-19 disaster drill with infection control guidelines was 90%. Post-drill debriefing sessions recommended reinforcing PPE training, ensuring availability of different sizes of PPEs and developing an algorithm to transfer patients to designated quarantine areas.
Conclusion: Simulation-based training and preparedness testing activities are vital in identifying gaps to apply corrective actions immediately. In the presence of a highly hazardous contagious disease like COVID-19, such exercises are a necessity to any healthcare institution.
{"title":"Simulation-based training programme and preparedness testing for COVID-19 using system integration methodology.","authors":"Hani M S Lababidi, Usamah Alzoraigi, Abdullah Abdulaziz Almarshed, Waleed AlHarbi, Mohamad AlAmar, Amer A Arab, Mahmoud A Mukahal, Faisal A AlAsmari, Bandar Y Mzahim, Husam A M AlHarastani, Salem S Alammi, Yousef I AlAwad","doi":"10.1136/bmjstel-2020-000626","DOIUrl":"https://doi.org/10.1136/bmjstel-2020-000626","url":null,"abstract":"<p><strong>Background: </strong>COVID-19 pandemic is presenting serious challenges to the world's healthcare systems. The high communicability of the COVID-19 necessitates robust medical preparedness and vigilance.</p><p><strong>Objective: </strong>To report on the simulation-based training and test preparedness activities to prepare healthcare workers (HCWs) for effective and safe handling of patients with COVID-19.</p><p><strong>Methodology: </strong>Two activities were conducted: simulation-based training to all HCWs and a full-scale unannounced simulation-based disaster exercise at King Fahad Medical City (KFMC). The online module was designed to enhance the knowledge on COVID-19. This module was available to all KFMC staff. The five hands-on practical part of the course was available to frontliner HCWs. The unannounced undercover simulated patients' full-scale COVID-19 simulation-based disaster exercise took place in the emergency department over 3 hours. Six scenarios were executed to test the existing plan in providing care of suspected COVID-19 cases.</p><p><strong>Results: </strong>2620 HCWs took the online module, 17 courses were conducted and 337 frontliner HCWs were trained. 94% of learners were satisfied and recommended the activity to others. The overall compliance rate of the full-scale COVID-19 disaster drill with infection control guidelines was 90%. Post-drill debriefing sessions recommended reinforcing PPE training, ensuring availability of different sizes of PPEs and developing an algorithm to transfer patients to designated quarantine areas.</p><p><strong>Conclusion: </strong>Simulation-based training and preparedness testing activities are vital in identifying gaps to apply corrective actions immediately. In the presence of a highly hazardous contagious disease like COVID-19, such exercises are a necessity to any healthcare institution.</p>","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmjstel-2020-000626","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9987611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-16eCollection Date: 2021-01-01DOI: 10.1136/bmjstel-2020-000645
Leo Nunnink, Andrea Thompson, Nemat Alsaba, Victoria Brazil
Introduction: Peer-assisted learning (PAL) is well described in medical education but there has been little research on its application in simulation-based education (SBE). This exploratory study aimed to determine the perceptions of senior medical students at two universities to teaching and learning in SBE using PAL (PAL-SBE).
Methods: Ninety-seven medical students at two universities working in small groups with facilitator oversight wrote, ran and debriefed a simulation scenario for their peers.This was a mixed-methods study. Participants completed a written free-text and Likert survey instrument, and participated in a facilitated focus group immediately after the scenario. Thematic analysis was performed on the free-text and focus group transcripts.
Results: Student-led scenarios ran without major technical issues. Instructor presence was required throughout scenario delivery and debrief, making the exercise resource intensive. Participant responses were more positive regarding learning as peer teachers in simulation than they were regarding participation as a peer learner. Five themes were identified: learning in the simulated environment; teaching in the simulated environment; teaching peers and taking on an educator role; learning from peers; and time and effort expended. Perceived benefits included learning in depth through scenario writing, improved knowledge retention, understanding the patient's perspective and learning to give feedback through debriefing.
Conclusion: PAL in SBE is feasible and was perceived positively by students. Perceived benefits appear to be greater for the peer teachers than for peer learners.
简介：同伴辅助学习（PAL）在医学教育中得到了广泛的应用，但有关其在模拟教学（SBE）中应用的研究却很少。这项探索性研究旨在确定两所大学的高年级医学生对使用 PAL（PAL-SBE）进行模拟基础教育的教学和学习的看法：方法：两所大学的 97 名医科学生在主持人的监督下以小组形式为同伴编写、运行和汇报模拟情景。参与者填写了一份自由文本和李克特调查问卷，并在情景模拟结束后立即参加了一个焦点小组。对自由文本和焦点小组记录进行了主题分析：结果：由学生主导的情景模拟在运行过程中没有出现重大技术问题。在情景模拟和汇报的整个过程中都需要指导教师在场，因此演练需要大量资源。与作为同伴学习者的参与相比，参与者对在模拟教学中作为同伴教师的学习反应更为积极。共确定了五个主题：在模拟环境中学习；在模拟环境中教学；教授同伴并承担教育者的角色；向同伴学习；花费的时间和精力。他们认为这样做的好处包括：通过情景写作深入学习、提高知识保留率、了解病人的观点以及学会通过汇报给予反馈：结论：PAL 在校本教育中的应用是可行的，并得到了学生的积极评价。结论：在学生健康教育中开展 PAL 是可行的，学生对其评价也是积极的。
{"title":"Peer-assisted learning in simulation-based medical education: a mixed-methods exploratory study.","authors":"Leo Nunnink, Andrea Thompson, Nemat Alsaba, Victoria Brazil","doi":"10.1136/bmjstel-2020-000645","DOIUrl":"10.1136/bmjstel-2020-000645","url":null,"abstract":"<p><strong>Introduction: </strong>Peer-assisted learning (PAL) is well described in medical education but there has been little research on its application in simulation-based education (SBE). This exploratory study aimed to determine the perceptions of senior medical students at two universities to teaching and learning in SBE using PAL (PAL-SBE).</p><p><strong>Methods: </strong>Ninety-seven medical students at two universities working in small groups with facilitator oversight wrote, ran and debriefed a simulation scenario for their peers.This was a mixed-methods study. Participants completed a written free-text and Likert survey instrument, and participated in a facilitated focus group immediately after the scenario. Thematic analysis was performed on the free-text and focus group transcripts.</p><p><strong>Results: </strong>Student-led scenarios ran without major technical issues. Instructor presence was required throughout scenario delivery and debrief, making the exercise resource intensive. Participant responses were more positive regarding learning as peer teachers in simulation than they were regarding participation as a peer learner. Five themes were identified: learning in the simulated environment; teaching in the simulated environment; teaching peers and taking on an educator role; learning from peers; and time and effort expended. Perceived benefits included learning in depth through scenario writing, improved knowledge retention, understanding the patient's perspective and learning to give feedback through debriefing.</p><p><strong>Conclusion: </strong>PAL in SBE is feasible and was perceived positively by students. Perceived benefits appear to be greater for the peer teachers than for peer learners.</p>","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8936843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89921345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-14DOI: 10.1136/bmjstel-2020-000592
Bridget Copson, S. Wijewickrema, Laurence Sorace, Randall W. Jones, S. O'Leary
Objective To investigate the effectiveness of a virtual reality (VR), three-dimensional (3D) clinically orientated temporal bone anatomy module, including an assessment of different display technologies. Methods A clinically orientated, procedural and interactive anatomy module was generated from a micro-CT of a cadaveric temporal bone. The module was given in three different display technologies; 2D, 3D with monoscopic vision, and 3D with stereoscopic vision. A randomised control trial assessed the knowledge acquisition and attitudes of 47 medical students though a pretutorial and post-tutorial questionnaire. The questionnaire included questions identifying anatomic structures as well as understanding structural relations and clinical relevance. Furthermore, a five-point Likert scale assessed the students’ attitudes to the module and alternative learning outcomes, such as interest in otology and preparedness for clinical rotations. Results As a whole cohort, the total test score improved significantly, with a large effect size (p≤0.005, Cohen’s d=1.41). The 23 students who returned the retention questionnaire had a significant improvement in total test score compared with their pretutorial score, with a large effect size (p≤0.005, Cohen’s d=0.83). Display technology did not influence the majority of learning outcomes, with the exception of 3D technologies, showing a significantly improvement in understanding of clinical relevance and structural relations (p=0.034). Students preferred 3D technologies for ease of use, perceived effectiveness and willingness to use again. Conclusions The developed VR temporal bone anatomy tutor was an effective self-directed education tool. 3D technology remains valuable in facilitating spatial learning and superior user satisfaction.
{"title":"Development of a virtual reality clinically oriented temporal bone anatomy module with randomised control study of three-dimensional display technology","authors":"Bridget Copson, S. Wijewickrema, Laurence Sorace, Randall W. Jones, S. O'Leary","doi":"10.1136/bmjstel-2020-000592","DOIUrl":"https://doi.org/10.1136/bmjstel-2020-000592","url":null,"abstract":"Objective To investigate the effectiveness of a virtual reality (VR), three-dimensional (3D) clinically orientated temporal bone anatomy module, including an assessment of different display technologies. Methods A clinically orientated, procedural and interactive anatomy module was generated from a micro-CT of a cadaveric temporal bone. The module was given in three different display technologies; 2D, 3D with monoscopic vision, and 3D with stereoscopic vision. A randomised control trial assessed the knowledge acquisition and attitudes of 47 medical students though a pretutorial and post-tutorial questionnaire. The questionnaire included questions identifying anatomic structures as well as understanding structural relations and clinical relevance. Furthermore, a five-point Likert scale assessed the students’ attitudes to the module and alternative learning outcomes, such as interest in otology and preparedness for clinical rotations. Results As a whole cohort, the total test score improved significantly, with a large effect size (p≤0.005, Cohen’s d=1.41). The 23 students who returned the retention questionnaire had a significant improvement in total test score compared with their pretutorial score, with a large effect size (p≤0.005, Cohen’s d=0.83). Display technology did not influence the majority of learning outcomes, with the exception of 3D technologies, showing a significantly improvement in understanding of clinical relevance and structural relations (p=0.034). Students preferred 3D technologies for ease of use, perceived effectiveness and willingness to use again. Conclusions The developed VR temporal bone anatomy tutor was an effective self-directed education tool. 3D technology remains valuable in facilitating spatial learning and superior user satisfaction.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83780463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-03DOI: 10.1136/bmjstel-2020-000659
A. Lane, C. Roberts
Introduction and objectives Open disclosure is a policy outlining how healthcare practitioners should apologise for mistakes, discussing them with the harmed parties. Simulation is a training and feedback method in which learners practise tasks and processes in lifelike circumstances. We explore how final-year medical students experience the learning of open disclosure. Methods A qualitative study of final-year medical students who had been involved a high-fidelity simulation session based on open disclosure after medication error was conducted. Students were selected using purposive sampling. Focus groups illuminated their experiences and interpretation of simulated open disclosure experiences. The data were analysed using interpretative phenomenological analysis and supported two superordinate themes: (1) identifying learning needs; and (2) learning to say sorry Results The medical students constructed their learning in three different ways: negotiating environmental relationships; embracing challenge and stress; and achieving learning outcomes. The data reinforced the need for psychological safety, emphasised the need for emotional arousal and demonstrated the need for both individual and collective reflective learning. Our data linked the benefits of experiential learning to the development of growth mindset and Jarvis’s theory. Conclusions The lived experience of the final-year medical student participants in this study reinforced the notions of continuous psychological safety and the need for emotional arousal during learning. Our data also demonstrated the variety of participant experiences when preparing to give open disclosure, reinforcing the need for facilitators to optimise learning for the whole group as well as the individuals, given that participants are at different parts of their learning cycle.
{"title":"Developing open disclosure strategies to medical error using simulation in final-year medical students: linking mindset and experiential learning to lifelong reflective practice","authors":"A. Lane, C. Roberts","doi":"10.1136/bmjstel-2020-000659","DOIUrl":"https://doi.org/10.1136/bmjstel-2020-000659","url":null,"abstract":"Introduction and objectives Open disclosure is a policy outlining how healthcare practitioners should apologise for mistakes, discussing them with the harmed parties. Simulation is a training and feedback method in which learners practise tasks and processes in lifelike circumstances. We explore how final-year medical students experience the learning of open disclosure. Methods A qualitative study of final-year medical students who had been involved a high-fidelity simulation session based on open disclosure after medication error was conducted. Students were selected using purposive sampling. Focus groups illuminated their experiences and interpretation of simulated open disclosure experiences. The data were analysed using interpretative phenomenological analysis and supported two superordinate themes: (1) identifying learning needs; and (2) learning to say sorry Results The medical students constructed their learning in three different ways: negotiating environmental relationships; embracing challenge and stress; and achieving learning outcomes. The data reinforced the need for psychological safety, emphasised the need for emotional arousal and demonstrated the need for both individual and collective reflective learning. Our data linked the benefits of experiential learning to the development of growth mindset and Jarvis’s theory. Conclusions The lived experience of the final-year medical student participants in this study reinforced the notions of continuous psychological safety and the need for emotional arousal during learning. Our data also demonstrated the variety of participant experiences when preparing to give open disclosure, reinforcing the need for facilitators to optimise learning for the whole group as well as the individuals, given that participants are at different parts of their learning cycle.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80970496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-27DOI: 10.1136/bmjstel-2020-000759
Jeffrey A. Wilhite, Harriet Fisher, L. Altshuler, E. Cannell, Khemraj Hardowar, K. Hanley, C. Gillespie, S. Zabar
Objective structured clinical examinations (OSCEs) provide a controlled, simulated setting for competency assessments, while unannounced simulated patients (USPs) measure competency in situ or real-world settings. This exploratory study describes differences in primary care residents’ skills when caring for the same simulated patient case in OSCEs versus in a USP encounter. Data reported describe a group of residents (n=20) who were assessed following interaction with the same simulated patient case in two distinct settings: an OSCE and a USP visit at our safety-net clinic from 2009 to 2010. In both scenarios, the simulated patient presented as an asthmatic woman with limited understanding of illness management. Residents were rated through a behaviourally anchored checklist on visit completion. Summary scores (mean % well done) were calculated by domain and compared using paired sample t-tests. Residents performed significantly better with USPs on 7 of 10 items and in two of three aggregate assessment domains (p<0.05). OSCE structure may impede assessment of activation and treatment planning skills, which are better assessed in real-world settings. This exploration of outcomes from our two assessments using the same clinical case lays a foundation for future research on variation in situated performance. Using both assessments during residency will provide a more thorough understanding of learner competency.
{"title":"Gasping for air: measuring patient education and activation skillsets in two clinical assessment contexts","authors":"Jeffrey A. Wilhite, Harriet Fisher, L. Altshuler, E. Cannell, Khemraj Hardowar, K. Hanley, C. Gillespie, S. Zabar","doi":"10.1136/bmjstel-2020-000759","DOIUrl":"https://doi.org/10.1136/bmjstel-2020-000759","url":null,"abstract":"Objective structured clinical examinations (OSCEs) provide a controlled, simulated setting for competency assessments, while unannounced simulated patients (USPs) measure competency in situ or real-world settings. This exploratory study describes differences in primary care residents’ skills when caring for the same simulated patient case in OSCEs versus in a USP encounter. Data reported describe a group of residents (n=20) who were assessed following interaction with the same simulated patient case in two distinct settings: an OSCE and a USP visit at our safety-net clinic from 2009 to 2010. In both scenarios, the simulated patient presented as an asthmatic woman with limited understanding of illness management. Residents were rated through a behaviourally anchored checklist on visit completion. Summary scores (mean % well done) were calculated by domain and compared using paired sample t-tests. Residents performed significantly better with USPs on 7 of 10 items and in two of three aggregate assessment domains (p<0.05). OSCE structure may impede assessment of activation and treatment planning skills, which are better assessed in real-world settings. This exploration of outcomes from our two assessments using the same clinical case lays a foundation for future research on variation in situated performance. Using both assessments during residency will provide a more thorough understanding of learner competency.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90195386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-17DOI: 10.1136/bmjstel-2020-000747
Sam Curtis, Rebecca L. Flower, Lola Emanuel-Kole, P. Nadarajah
The Royal Free Hospital is one of four High Consequence Infectious Disease centres in England and as of the end of May 2020, seven women were confirmed COVID-19 peri-delivery. We developed a standard operating procedure (SOP) for suspected and confirmed COVID-19 women undergoing operative delivery. This was revised in response to our ongoing clinical experience and changes in guidance from medical and public health organisations. Following 10 weeks of clinical practice, we formally tested the SOP using point-of-care simulation to enable optimisation for a potential second surge. Our high-fidelity simulation of a COVID-19-positive parturient requiring an emergency caesarean was facilitated by the simulation team in our obstetric unit. It was designed to test the performance and safety of our SOP as well as staff performance. We used the Failure Modes and Effect Analysis tool (a systematic, prospective method of process mapping) to identify how a complex task might fail and assess the relative impact of different failures. The decision-to-delivery was 17 minutes, which we considered to be successful. However, a number of operational deficiencies were identified. The main failures related to lack of situational awareness, ill-fitting personal protective equipment and difficulties communicating between theatre and the neonatal teams located outside, posing serious potential risks to safe neonatal care. Subsequently, we have modified our SOP to include a communication check, implemented communication training for the neonatal team and organised further simulation training for theatre staff unfamiliar with COVID-19 considerations.
{"title":"Failure modes and effects analysis to assess COVID-19 protocols in the management of obstetric emergencies","authors":"Sam Curtis, Rebecca L. Flower, Lola Emanuel-Kole, P. Nadarajah","doi":"10.1136/bmjstel-2020-000747","DOIUrl":"https://doi.org/10.1136/bmjstel-2020-000747","url":null,"abstract":"The Royal Free Hospital is one of four High Consequence Infectious Disease centres in England and as of the end of May 2020, seven women were confirmed COVID-19 peri-delivery. We developed a standard operating procedure (SOP) for suspected and confirmed COVID-19 women undergoing operative delivery. This was revised in response to our ongoing clinical experience and changes in guidance from medical and public health organisations. Following 10 weeks of clinical practice, we formally tested the SOP using point-of-care simulation to enable optimisation for a potential second surge. Our high-fidelity simulation of a COVID-19-positive parturient requiring an emergency caesarean was facilitated by the simulation team in our obstetric unit. It was designed to test the performance and safety of our SOP as well as staff performance. We used the Failure Modes and Effect Analysis tool (a systematic, prospective method of process mapping) to identify how a complex task might fail and assess the relative impact of different failures. The decision-to-delivery was 17 minutes, which we considered to be successful. However, a number of operational deficiencies were identified. The main failures related to lack of situational awareness, ill-fitting personal protective equipment and difficulties communicating between theatre and the neonatal teams located outside, posing serious potential risks to safe neonatal care. Subsequently, we have modified our SOP to include a communication check, implemented communication training for the neonatal team and organised further simulation training for theatre staff unfamiliar with COVID-19 considerations.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80563599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-13eCollection Date: 2021-01-01DOI: 10.1136/bmjstel-2020-000646
Rachel Bican, Jill C Heathcock, Flora Jedryszek, Veronique Debarge, Julien DeJonckheere, M C Cybalski, Sandy Hanssens
Introduction: Postpartum haemorrhage is the leading cause of maternal death. Healthcare simulations are an educational tool to prepare students for infrequent high-risk emergencies without risking patient safety. Efficiency of movement in the simulation environment is important to minimize the risk of medical error. The purpose of this study was to quantify the movement behaviours of the participants in the simulation and evaluate the relationship between perceived stress and movement.
Methods: N=30 students participated in 10 high-fidelity medical simulations using an adult patient simulator experiencing a postpartum haemorrhage. The participants completed the State-Trait Anxiety Inventory prior to the simulation to measure perceived stress. Physical movement behaviours included walking around the simulation, time spent at bedside, arm movements, movements without purpose, looking at charts/vitals and total movement.
Results: Midwife (MW) students spent significantly more time walking (p=0.004) and looking at charts/vitals (p=<0.001) and significantly less time at bedside (p=<0.001) compared to obstetric (OB) students. The MW students demonstrated significantly more total movements compared to the OB students (p=<0.001). There was a significant, moderate, positive relationship between perceived stress and total movement during the simulation for the MW group (r=0.50, p=0.05). There was a trend for a moderate, positive relationship between perceived stress and total movement during the simulation for the OB group (r=0.46, p=0.10).
Conclusions: Physical movement during a simulation varies by job role and is influenced by perceived stress. Improved understanding of physical movement in the simulation environment can improve feedback, training and environmental set-up.
{"title":"Job role and stress influence student movement during postpartum haemorrhage simulation: an exploratory study.","authors":"Rachel Bican, Jill C Heathcock, Flora Jedryszek, Veronique Debarge, Julien DeJonckheere, M C Cybalski, Sandy Hanssens","doi":"10.1136/bmjstel-2020-000646","DOIUrl":"10.1136/bmjstel-2020-000646","url":null,"abstract":"<p><strong>Introduction: </strong>Postpartum haemorrhage is the leading cause of maternal death. Healthcare simulations are an educational tool to prepare students for infrequent high-risk emergencies without risking patient safety. Efficiency of movement in the simulation environment is important to minimize the risk of medical error. The purpose of this study was to quantify the movement behaviours of the participants in the simulation and evaluate the relationship between perceived stress and movement.</p><p><strong>Methods: </strong>N=30 students participated in 10 high-fidelity medical simulations using an adult patient simulator experiencing a postpartum haemorrhage. The participants completed the State-Trait Anxiety Inventory prior to the simulation to measure perceived stress. Physical movement behaviours included walking around the simulation, time spent at bedside, arm movements, movements without purpose, looking at charts/vitals and total movement.</p><p><strong>Results: </strong>Midwife (MW) students spent significantly more time walking (p=0.004) and looking at charts/vitals (p=<0.001) and significantly less time at bedside (p=<0.001) compared to obstetric (OB) students. The MW students demonstrated significantly more total movements compared to the OB students (p=<0.001). There was a significant, moderate, positive relationship between perceived stress and total movement during the simulation for the MW group (r=0.50, p=0.05). There was a trend for a moderate, positive relationship between perceived stress and total movement during the simulation for the OB group (r=0.46, p=0.10).</p><p><strong>Conclusions: </strong>Physical movement during a simulation varies by job role and is influenced by perceived stress. Improved understanding of physical movement in the simulation environment can improve feedback, training and environmental set-up.</p>","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8936709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85060357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-12eCollection Date: 2021-01-01DOI: 10.1136/bmjstel-2020-000740
Ahed Zeidan, Hany Tallat Abdelgelil, Edward Edwin, Dhafer Alqarni
{"title":"Apple Siri as communication conduit during COVID-19: between inside and outside the OR.","authors":"Ahed Zeidan, Hany Tallat Abdelgelil, Edward Edwin, Dhafer Alqarni","doi":"10.1136/bmjstel-2020-000740","DOIUrl":"10.1136/bmjstel-2020-000740","url":null,"abstract":"","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8936690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83877326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-01DOI: 10.1136/BMJSTEL-2020-ASPIHCONF.124
R. Edwards, Carl Heffernan
When Covid-19 hit, all student placements were suspended. Whilst some students were given honorary employment contracts, others had to isolate to care for families, or shield. This created anxiety from those at home, worried that they would be left behind with their learning. They were still able to have remote teaching from their lecturers, so we looked to add some remote simulation (sim) to this. Through an online learning platform, we were able to share the audio-visual directly from the sim suite. Students could talk in real time into the sim suite. Due to social distancing, we invited only two employed students to physically be in the sim suite for the session, with everyone else participating remotely. One remote learner was nominated to lead each sim, as if running a scenario in a ‘hands-off’ style. The nominated remote learner could ask questions directly to the patient and act on the responses. The two employed students acted as team members, taking a blood pressure and listening to the chest, under the instruction of the remote leader. Summary of Results We have made changes throughout, such as the number of participants or who should talk out loud and lead. Feedback has been constructive and has helped guide some of these changes over the weeks, it’s also been overwhelmingly positive and attendance has been high. Discussion, Conclusions and Recommendations Studies addressing ‘remote simulation’ currently only refer to the facilitator being remote (Hayden, 2012) and participants on the whole are physically present in educational facilities (Ikeyama, 2012). We will be continuing this method of sim and it’s likely to be a method we will adopt to complement hands-on sim. We are trialling varying numbers of participants to find the optimal number; currently we invite 15 remote learners. We ironed-out initial issues such as audio quality and session format. This method allows for social distancing and reduced travelling between sites. It could also allow more students access to sim, if larger group sizes prove to be effective. Feedback suggests that it should be used to supplement in-person sim rather than replace it, as in-person sim allows for the practice of hands on skills and inter-personal interactions. References Hayden E, Navedo D, Gordon J. Web-conferenced simulation sessions: a satisfaction survey of clinical simulation encounters via remote supervision. Telemedicine journal and e-health 2012:18 (7);p525–529. Ikeyama T, Shimizu N, Ohta K. Low-cost and ready-to-go remote-facilitated simulation-based learning. Simulation in healthcare 2012;7(1); p35–39.
当Covid-19袭来时，所有学生的实习都被暂停了。虽然一些学生获得了荣誉就业合同，但其他人不得不被隔离照顾家庭或庇护。这引起了家里学生的焦虑，担心他们的学习进度会落后。他们仍然可以从他们的讲师那里进行远程教学，所以我们希望在其中添加一些远程模拟(sim)。通过在线学习平台，我们可以直接分享模拟套件中的视听内容。学生们可以对着模拟套件进行实时对话。由于社交距离的原因，我们只邀请了两名在职学生参加模拟会议，其他所有人都远程参与。一名远程学习者被提名领导每个模拟模拟，就好像在以“不干涉”的方式运行一个场景。指定的远程学习者可以直接向患者提问，并根据回答采取行动。这两名受雇的学生作为小组成员，在远程领导的指导下测量血压和听胸。我们在整个过程中都做了一些改变，比如参与者的数量，或者谁应该大声说话和领导。反馈是建设性的，并在几周内帮助指导了一些变化，它也非常积极，出勤率很高。讨论、结论和建议针对“远程模拟”的研究目前仅指促进者是远程的(Hayden, 2012)，参与者总体上是在教育设施中(Ikeyama, 2012)。我们将继续这种模拟的方法，这可能是一种方法，我们将采用补充动手模拟。我们对不同数量的参与者进行试验，以找到最优人数;目前我们邀请了15名远程学习者。我们解决了最初的问题，如音频质量和会话格式。这种方法允许社交距离和减少站点之间的旅行。如果更大的团体规模被证明是有效的，它还可以让更多的学生接触到sim。反馈表明，它应该用来补充真人模拟，而不是取代它，因为真人模拟允许实践的技能和人际互动。Hayden E, Navedo D, Gordon J.网络会议模拟会议:通过远程监督的临床模拟遭遇满意度调查。远程医疗杂志和电子卫生2012:18 (7);p525-529。Ikeyama T, Shimizu N, Ohta K.低成本和随时可用的远程辅助模拟学习。医疗保健模拟2012;7(1);p35-39。
{"title":"PG76 Remote Simulation","authors":"R. Edwards, Carl Heffernan","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.124","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.124","url":null,"abstract":"When Covid-19 hit, all student placements were suspended. Whilst some students were given honorary employment contracts, others had to isolate to care for families, or shield. This created anxiety from those at home, worried that they would be left behind with their learning. They were still able to have remote teaching from their lecturers, so we looked to add some remote simulation (sim) to this. Through an online learning platform, we were able to share the audio-visual directly from the sim suite. Students could talk in real time into the sim suite. Due to social distancing, we invited only two employed students to physically be in the sim suite for the session, with everyone else participating remotely. One remote learner was nominated to lead each sim, as if running a scenario in a ‘hands-off’ style. The nominated remote learner could ask questions directly to the patient and act on the responses. The two employed students acted as team members, taking a blood pressure and listening to the chest, under the instruction of the remote leader. Summary of Results We have made changes throughout, such as the number of participants or who should talk out loud and lead. Feedback has been constructive and has helped guide some of these changes over the weeks, it’s also been overwhelmingly positive and attendance has been high. Discussion, Conclusions and Recommendations Studies addressing ‘remote simulation’ currently only refer to the facilitator being remote (Hayden, 2012) and participants on the whole are physically present in educational facilities (Ikeyama, 2012). We will be continuing this method of sim and it’s likely to be a method we will adopt to complement hands-on sim. We are trialling varying numbers of participants to find the optimal number; currently we invite 15 remote learners. We ironed-out initial issues such as audio quality and session format. This method allows for social distancing and reduced travelling between sites. It could also allow more students access to sim, if larger group sizes prove to be effective. Feedback suggests that it should be used to supplement in-person sim rather than replace it, as in-person sim allows for the practice of hands on skills and inter-personal interactions. References Hayden E, Navedo D, Gordon J. Web-conferenced simulation sessions: a satisfaction survey of clinical simulation encounters via remote supervision. Telemedicine journal and e-health 2012:18 (7);p525–529. Ikeyama T, Shimizu N, Ohta K. Low-cost and ready-to-go remote-facilitated simulation-based learning. Simulation in healthcare 2012;7(1); p35–39.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74600542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-01DOI: 10.1136/BMJSTEL-2020-ASPIHCONF.169
R. Makker, Emma Prince, Bruce Kerr
Introduction Overseas doctors (International Medical Graduates) constitute an important and significant workforce for provision of healthcare in NHS. Most of them have demonstrated their knowledge and skills to practice Medicine. However, to be able to deliver healthcare successfully in the NHS, they need to adapt to the culture within the NHS. It is incumbent on employers to provide an educational program to help IMG integrate in the NHS. However, the Covid crisis has posed a challenge to deliver conventional teaching. We describe an innovative educational programme for IMG working at six NHS hospitals, commissioned by Health Education, East of England (HEEE). Methodology The programme consisted of two days of interactive zoom sessions over a month delivered by experts in skills and simulation. The two sessions focussed on developing their personal and clinical skills. IMGs were informed about the programme via e mail and twenty participants attended. The programme on Day one dealt with building self-awareness of key skills to progress in NHS safely, with confidence. We designed a bespoke programme to develop their personal skills by introducing concepts of mindfulness, being proactive, building resilience to deal with rejection and setbacks, building optimism, understanding the importance of robust well- being strategies. It was delivered by the Director of an external educational platform, as an interactive zoom meeting complemented by power point presentation. Clinical skills session on day two was delivered as remote simulation with pre-recorded scenarios to demonstrate structured A to E assessment of a critically ill patient, handover and communication within a team using SBAR, management of sepsis and Asthma and efficacy of simulation in immediate performance improvement by demonstrating same team management of a cardiac arrest scenario. Debriefing was conducted via zoom, inviting the participants to comment on the actors’ performance. Summary of Results/Outcomes We found that in the current constraints of the Covid crisis, it was possible to construct a two-day programme for IMGs delivered by expert, using remote technology. Minimal resources were required. On reflection, educators found a high level of interest, engagement and interaction by the IMGs. Written feedback from the participants supported the educators’ perception. Additionally, they reported satisfactory quality of audio visual technology, and usefulness of the power point presentations. IMGs reported that debriefing in simulation about the actors’ performance was realistic. Discussion, Conclusions and Recommendations We conclude that it is possible to deliver education to develop personal and clinical skills to IMGs remotely. Debriefing by zoom was engaging, powerful and an educationally effective, innovative method. Recommendations Remote simulation preceded by skills introduction for IMG may be useful for large audiences, in different geographical areas in crisis times and
{"title":"PG121 Masterclass for key-skills and remote simulation in covid times for international medical graduates (IMG): an innovative educational programme","authors":"R. Makker, Emma Prince, Bruce Kerr","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.169","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.169","url":null,"abstract":"Introduction Overseas doctors (International Medical Graduates) constitute an important and significant workforce for provision of healthcare in NHS. Most of them have demonstrated their knowledge and skills to practice Medicine. However, to be able to deliver healthcare successfully in the NHS, they need to adapt to the culture within the NHS. It is incumbent on employers to provide an educational program to help IMG integrate in the NHS. However, the Covid crisis has posed a challenge to deliver conventional teaching. We describe an innovative educational programme for IMG working at six NHS hospitals, commissioned by Health Education, East of England (HEEE). Methodology The programme consisted of two days of interactive zoom sessions over a month delivered by experts in skills and simulation. The two sessions focussed on developing their personal and clinical skills. IMGs were informed about the programme via e mail and twenty participants attended. The programme on Day one dealt with building self-awareness of key skills to progress in NHS safely, with confidence. We designed a bespoke programme to develop their personal skills by introducing concepts of mindfulness, being proactive, building resilience to deal with rejection and setbacks, building optimism, understanding the importance of robust well- being strategies. It was delivered by the Director of an external educational platform, as an interactive zoom meeting complemented by power point presentation. Clinical skills session on day two was delivered as remote simulation with pre-recorded scenarios to demonstrate structured A to E assessment of a critically ill patient, handover and communication within a team using SBAR, management of sepsis and Asthma and efficacy of simulation in immediate performance improvement by demonstrating same team management of a cardiac arrest scenario. Debriefing was conducted via zoom, inviting the participants to comment on the actors’ performance. Summary of Results/Outcomes We found that in the current constraints of the Covid crisis, it was possible to construct a two-day programme for IMGs delivered by expert, using remote technology. Minimal resources were required. On reflection, educators found a high level of interest, engagement and interaction by the IMGs. Written feedback from the participants supported the educators’ perception. Additionally, they reported satisfactory quality of audio visual technology, and usefulness of the power point presentations. IMGs reported that debriefing in simulation about the actors’ performance was realistic. Discussion, Conclusions and Recommendations We conclude that it is possible to deliver education to develop personal and clinical skills to IMGs remotely. Debriefing by zoom was engaging, powerful and an educationally effective, innovative method. Recommendations Remote simulation preceded by skills introduction for IMG may be useful for large audiences, in different geographical areas in crisis times and","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75895139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号